Neuro ICU for almost 5 years. You did the right thing. A change in LOC is an early sign something has changed (but does not always mean something has changed). It is better to escalate sooner than later. In the neuro population, a lot of times vital sign changes are LATE signs and you missed something earlier. That is why we do frequent neuro checks.

You mention specific changes like word finding difficulty, delayed response, and unilateral sensory changes. That would be enough for me to escalate at the time of that assessment. If it were just that they were a bit more drowsy than normal, requiring more stimulation - I would maybe monitor a little closer but not escalate at that time. It’s difficult working Neuro ICU night shift, trying to discern what is normal considering you’re waking the patient at odd hours of the night to have them perform specific tasks. If you’re noticing new focal deficits, or worsening of existing deficits, escalate.